Trial of early neonatal hydrocortisone: two-year follow-up.
BACKGROUND
Dexamethasone treatment is associated with an increased risk of cerebral palsy (CP). Early hydrocortisone (HC) treatment may decrease the incidence of bronchopulmonary dysplasia; however, the long-term effects are still under evaluation. Follow-up of randomized studies concerning early HC treatment is essential to confirm the long-term safety.


OBJECTIVE
We hypothesized that early HC treatment in very preterm infants does not impair the neurologic outcome.


METHODS
We report follow-up data from a randomized trial of early HC given for 10 days. Before the HC or placebo treatment, serum cortisol levels were measured. Receiver-operating characteristic was defined. Values below the median were classified as low endogenous cortisol and those above the median as high endogenous cortisol. A meta-analysis was performed.


RESULTS
Altogether 98% of the 46 surviving infants participated in a follow-up study at a corrected age of 2 years. The growth characteristics were similar between the study groups. The developmental quotients (DQs) of the children with high endogenous cortisol and placebo treatment shortly after birth (100 +/- 13) and those with low endogenous cortisol and HC (97 +/- 7) were not lower than the DQs of the children with high endogenous cortisol and HC (92 +/- 3) or low cortisol and placebo (96 +/- 2). According to a meta-analysis of three available trials (411 children), the rate of CP and survival without neurosensory or cognitive impairment was not influenced by HC.


CONCLUSIONS
Early low-dose HC administration had no adverse effects at 2 years of age. Further studies are required to define the target group for neonatal HC.
Peltoniemi
Outi M
OM
Department of Pediatrics, University of Oulu, Oulu, Finland. outi.peltoniemi@mail.suomi.net
Lano
Aulikki
A
Puosi
Riina
R
Yliherva
Anneli
A
Bonsante
Francesco
F
Kari
M Anneli
MA
Hallman
Mikko
M
D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001997:Bronchopulmonary Dysplasia / Q000097:blood / Q000188:drug therapy*; D002657:Child Development / Q000187:drug effects* / Q000502:physiology; D002675:Child, Preschool; D005260:Female; D006128:Growth / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D007231:Infant, Newborn; D008297:Male; D015201:Meta-Analysis as Topic; D011237:Predictive Value of Tests; D012372:ROC Curve; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone